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Brynes, Kenneth Charles r ( i ) itzz. NEW YORK STATE DEPARTMENT OF HEALTH ........,_-- Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kenneth Charles Brynes Male Date of Death Age If Veteran of U.S.Armed Forces, 03/03/2023 64 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death Z Natural Cause Accident El Homicide Suicide ElUndetermined El Pending W C.) Circumstances Investigation W Medical Certifier Name Title G Bo Li MD Address 100 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 126 Burial Date Cemetery,Crematory or Facility Name 03/08/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held F- Hold Address N O O. Date Point of W❑Transportation Shipment Q by Common — - Carrier Destination El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 2 Address C W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/08/2023 Registrar of Vital Statistics MeganTrolin(Electronically Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 3)1 I Z3 Place of Disposition ,. W (address) W U) (section) 4 (lot number) (grave number) g Name of Sexton or Person in Charge of ises tt f /p ase print) W Signature Title irxer ll'e DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on 4ttrial1pepmit Official Funeral Directors Reg.or License#